Prof. Dr. Werner Seebauer is Dean of Studies – Association of German Preventologists, Head of Preventive Medicine Department of Institute of Transcultural Health Sciences (European University Viadrina), and Head of Preventive Medicine – NESA (The New European Surgical Academy). Since 2000, prof. dr. Werner Seebauer worked only in preventive medicine, after ten years spent at the Frankfurt University Hospital. He is also involved in medical professionals training for nutrition and prevention.
MediHelp International contributes to medical science development and is actively involved in international social responsibility advocacy.
You are very important for us, therefore MediHelp International provides you the access to critical information for your wellbeing offered by Prof. Dr. Werner Seebauer, a specialist in preventive medicine and nutrition.
1. Summary Rules of Conduct - DHEM distance, hygiene, everyday masks
To reduce the risk of transmission, people should follow the DHEM rules (keep away from other people, adhere to hygiene rules, and wear everyday masks) in everyday life.
If an infection has been diagnosed, or due to a contact or stay in an environment with high infection rates (e.g. in a hotel or bar with infected persons, etc.) and there is a suspicion of a higher probability of infection, rapid isolation (see quarantine) can prevent the spread.
Early quarantine is advisable in any case for the positively tested people as well as the close contact-persons. For the identification of such persons should serve appropriate tracking APPs.
2. Quarantine/ Infectivity duration
If someone is infected and you want to avoid spreading through that person and his or her closer contact environment, you must observe isolation.
The term quarantine comes from the Latin "quaranta" and meant during the plague pandemic in the 14th century, the isolation over 40 days (quaranta). The quarantine time varies depending on the of infection transmission. For COVID-19 it is set to 14 days.
How long a person infected with the coronavirus COVID-19 is contagious cannot be said in general terms (too low study data) it also depends on the severity of the disease.
The decision as to whether a person is considered to be recovered and/or no longer contagious (the quarantine may be terminated) is taken by the local competent health authority with the treating physicians.
Those who have only a reasonable suspicion of potential contagion (proven contact* with at least one infected person – or stay in the same place(e.g. classroom, workplace, apartment/household, extended family circle, hospital, other residential facility, barracks or holiday camp)but are asymptomatic, are not initially isolated, but better monitored.
If there is a reasonable suspicion of contact (see box below), an immediate test is advantageous, since then the isolation or quarantine after a positive infection result could be achieved more quickly even for the first asymptomatic days. However, the detection of infection may be uncertain. The test (smear from the upper respiratory pathways) should take place immediately after the suspicion and additionally 5-7 days after the first exposure again.
Contact person tracking for respiratory diseases caused by the coronavirus COVID-19
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* Contacts with justified suspicion of infection (contact with positively infected person) are divided into different categories depending on the risk of infection. Category 1 means a higher risk of infection. The concerning (classification of the RKI):
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Note: At the beginning of the pandemic, suspected cases (first-degree contact persons – see above) were placed in 14-day quarantine also without symptoms for safety reasons, and even negative test results did not give them reasons to a shortening of the quarantine period. Today, quarantine is not ordered until a positive test result of an infection is detected. In the case of a first-degree contact, a test should be carried out as early as possible, i.e. on day one after determination and additionally 5-7 days after initial exposure, since then the highest probability of a pathogen detection is. It should be emphasized that a negative test result does not replace health monitoring or, if necessary, a later positive result does not shorten the quarantine time. |
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Therefore, if the person with reasonable suspicion of contact with a positively tested person, shows symptoms of SARS-CoV-2 infection within 14 days of the last contact, he is considered to be suspected of illness, and a further diagnostic examination must be carried out. In the event of a positive infection result, the isolation is then also necessary, and the procedure of the control of the closer contact environment of this person must be carried out. The following procedure is recommended:
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In people with symptoms of COVID-19 (even if it is only a mild course), the domestic quarantine shall be lifted at the earliest 14 days after the onset of the disease, and at least 48 hours no longer having any signs of illness. If symptoms were present until the 13th day, the quarantine is extended until the 16th day.
In the case of people for whom the pathogen virus has been detected at the beginning of domestic quarantine but who do not develop signs of disease (asymptomatic infection), release from quarantine is possible at the earliest after 14 days. The decision as to whether a person can leave the home quarantine is made by the local competent health authority in consultation with the medical care. If symptoms occur, the course of the disease and the therapy determine the further necessary measures.
Asymptomatic cases- Contact persons tracking:
In situations where there is no further information about an infected but asymptomatic person, it is not possible to know when exactly the person was infectious. It always requires a case-by-case decision.
If there is no particular risk situation, the infectivity is assumed from the date of the positive test result minus 2 days before the sampling date; all contact persons during this time must be tracked. This is a pragmatic approach because the incubation period of up to 14 days would potentially involve considerably more contacts. The end of the infectious period is not certain to be specified currently. As emphasized, the incubation period is not equated with the infectivity duration of an infected person.
For the source of infection of the asymptomatic infected person (if known where he is most likely infected), his contact persons can be assumed to be potentially infected from the third day of his infection.
3. How many people are infected? Manifestation Index (RKI
The Manifestations Index describes the proportion of those infected who are ill. Until today, only estimations are still available from some better-studied groups in certain regions; in many places, there are still too few investigations. Besides, the number of infections depends on certain conditions (risk structures) as well as on the multiple measurements over a longer course.
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The identification of infected persons also depends on the time and frequency of the examination. A once tested person, who has been tested negative, can theoretically be infected and be positive shortly afterward, without this being noticed, because many infected people remain asymptomatic, or can have non-specific mild symptoms, which then gives no reason for re-examination. Only repeated multi-tests on larger proportions of the population (including in people without symptoms) will provide better assessments of the manifestation index (infection numbers and manifestation numbers) and the percentage rate of severe disease. |
Until now, specialist institutes such as the RKI have discouraged the untargeted testing of asymptomatic persons due to the unclear significance of a negative result (it is only a snapshot). However, if these tests are performed more frequently in asymptomatic individuals (at intervals of e.g. 1-2 weeks), much more will be able to say - much more about the infection rates of asymptomatic individuals. This makes more sense if more potentially infected people can be expected already. In regions with higher infection rates, this is more meaningful. Therefore, the specialist institutions will adjust their attitudes to this.
As already shown, it is estimated from previous major evaluations that on average about 43% of those infected do not show any symptoms.
Based on some targeted studies in people without symptoms, the number of people infected is estimated to be 4.5-11 times higher than in the studies based on existing symptoms that suggested COVID-19 infection.
Series examination of more young people (these are more often symptomless) already reveals higher infection rates. In the case of groups under certain local conditions, which require closer contacts, one can see significantly higher manifestation numbers, if an infectious person is there (especially superspreaders). For example, on some cruise ships, 82% were seen, evacuated returnees 69%, and at nursing homes up to 86%; an older village population in Italy estimated 56.8% of infected people.
Depending on the transmission pathways (see below), there are different infection conditions.
The actual number of people with the disease is therefore still unknown and is likely to be significantly higher in many places than the number of symptomatic persons or reported cases of the disease.
4. Manifestations, Complications, and Consequences (RKI)
Risk groups - groups of people with more frequent severe disease historiesno symptoms/ severe course /long-term-consequential damage. What is the risk of pregnant women, infants, and children?
Severe course and lethality (data of the RKI for Germany)
In Germany, the proportion of lethality is currently 4.7%. A study from China estimated the number of people who died in a patient group of 1,099 at 8.1% of serious illnesses (lung failure or sepsis) and 0.1% (1/ 926) in mild illnesses(1.4%intotal) and among patients with a very severe course (e.g. lung failure) at 22%.
Lethality describes the number of deceased as a proportion of the number of (actually) cases. If the number of cases falling by a factor of 4.5-11.1 is indeed underestimated, then this would mainly affect the number of mildly ill people not covered by the monitoring system. This would probably reduce the percentage of the lethality of the total population by a similar factor. However, in the case of severe gradients, lethality will be between 8-22% at present. This also depends on the capacities and facilities of the intensive care units. Therefore, the data given here are correct for Germany at this stage (with sufficient capacity). In other countries, this can be quite different. It is also difficult to correlate death numbers only to COVID-19 infections, as it can have increasingly serious consequences in the risk groups, e.g. with already advanced cardiovascular and/or lung diseases and older age, or additional other diseases (e.g. a systemic infection).
Risk groups (RKI classification according to international study data)
Overview: Severe disease histories are observed more frequently in the following groups of people:
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Note on smoking: while some reviews do not see an increased risk between smoking and COVID-19 disease, others describe a more severe course of the disease due to the increased inflammation of the pulmonary mucosa. The increased inflammation and thus serious illnesses are plausible because the smoking history correlates with much more inflammatory messengers (pro-inflammatory cytokines/chemokines), which lead to more severe lung tissue damage.
In any case, smoking should also be avoided in the context of COVID-19 to reduce risks!
Note on age: the nature of pre-existing conditions (see below) is likely to be more relevant than age alone. Older people, however, often have such pre-existing conditions, which is why the age has a high correlation to severe disease histories. In all countries where studies with COVI-19 infections have been carried out so far, a significant increase in the serious progression with older age is shown. A comparison between South Korea, Spain, China, and Italy shows the following figures in the graph:
Onder G, et al. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA.Published online March 23, 2020. doi:10.1001/jama.2020.4683.
The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Chinese CDC Weekly. Available at: https://cdn.onb.it/2020/03/COVID-19.pdf.pdf.
More details
Groups of people who, according to previous findings, have a higher risk of serious complications of the disease:
The risk of a serious illness increases steadily from the age of 50 to 60 (much more with 80+). Older people are more likely to develop an infection more severely due to the less responsive immune system (immune senescence >> Communication between immune defense cells no longer works as well). Since non-specific symptoms of the disease, such as fever, can be weaker or absent in old age, which means that sufferers then go to the doctor later.
Various underlying diseases, such as cardiovascular and/or lung diseases, diabetes, cancers, but also diseases of the liver and kidney, can lead to multiple dysfunctions of the organism more quickly and thus lead to more serious disease histories in infections.
Similarly, a significant overweight (especially obesity) as well as smoking can weaken various organ functions and contribute to overall heavier diseases. A smoker always has an attacked pulmonary epithelium (has no healthy lungs!).
In the case of pre-existing diseases, the risk of a serious course of the disease is higher than if there is only one factor (age or some basic disease isolated); multi-morbidity always increases the risks. There is a higher risk for patients with weakened immune systems (e.g. due to certain diseases, or because of taking medications such as cortisone, which can weaken the immune system).
The consequences of infection and immune functions are always dependent on many factors; therefore it is not possible to define the risk classifications in a general way. Individual classification according to the present condition is always required to be able to assess the risk more concretely. As has been pointed out several times, different lifestyle factors always play a role; both in primary prevention and secondary prevention, i.e. the manifestation and course of a disease, as well as in the case of infection.
What is the risk of pregnant women, infants, and children?
Children
In most available studies, children are likely less affected than adults to get a manifestation of COVID-19 infection. And when they are affected, they are more likely to have mild symptoms or more asymptomatic disease. Severe histories are rare and particularly affect infants and young children. In rare cases, sick older children and adolescents can develop a severe spread but treatable inflammatory response (referred to as "multi-systemic inflammatory syndrome" similar to the Kawasaki syndrome).
Although children appear to be slightly less susceptible to coVID-19 infection, previous studies of viral load in children show no significant difference from adults. So, they probably have no lower risk of transmission.
Since children and adolescents usually have more frequent and closer physical contacts in their daily situations, a transfer between them and adults is favored. Since the kindergarten and schools were closed quickly in the lockdown and the highest infection rates had already been reduced after limited reopening, the number of infections with open educational institutions is not known. In some regions, there were few infections, but in others, there were quick new infections.
The protection measures for reducing the number of transmissions by children and adolescents will still have to be adapted to the experiences to be made, which can vary widely.
Pregnant
Currently, there is also insufficient data on COVID-19 infection in pregnancy and effects on the unborn. Due to physiological adjustments and immunological processes, there could be an increased risk of infection. In the case of infection, however, pregnant women appear to develop no or only mild symptoms mostly.
In general, high fever during the first third of pregnancy may increase the risk of complications and malformations, but this has barely been observed in connection with COVID 19.
The possibility of transmission in the womb and immune reactions in newborns is physiologically possible. In most cases, children from COVID-19 positive mothers show after birth no signs of disease. If signs of infection have been observed in the infant period, it is unclear whether transmission via breast milk is possible. It is assumed that the transmission is via the respiratory tract since in the reported cases the mothers were asymptomatic in the first days of infectivity (usually already 1-3 days before the first symptoms) and did not wear mouth-nasal protection. Overall, the data is not yet sufficient to answer all questions about COVID-19 in pregnancy safely.
Long-term consequential damage
It is currently thought that on average about 81% of the diagnosed persons show a mild, about 14% a heavier and about 5% a particularly severe course of the disease. These data cannot be generalized. In some regions, for example, China had about 9% very severe courses, while in other countries very few serious courses have been seen.
Long-term follow-up damage is to be expected after the severe progressions more likely. In addition to the damage in the lungs, an infestation of nerve cells, the cardiovascular system, kidney tissue, and other organ systems are also seen. As emphasized, this depends on pre-existing diseases, genetic factors, age and immune reactions(in the immune reactions, on the one hand, a weakened immune system plays a role in the primary infection and on the other hand over excessive immune reactions in the virus defense).
Since the serious COVID-19 infections have not only caused serious lung damage, serious inflammation in the blood vessels as well as damage to the central nervous system (encephalopathies) and blood clotting disorders with thrombosis and pulmonary embolism, some physicians suspect that even less acute cases in this context may cause later problems. It is not known whether such long-term damage occurs in people who have not had a serious course of infection. However, there is no reliable data on this yet.
In any case, a link in patho-physiology (disease development and expression) can be explained by previously damaged structures – i.e. existing pre-diseases of the cardiovascular region and other chronic diseases. The COVID-19 infection can then significantly increase various pre-damages. After all, such connections can also be seen in other viral diseases. Pre-sick people must always better avoid infections.
5. Second and other waves/immunity
The vast majority of the population still has no immune protection against COVID-19.
In countries or regions where infection rates have already decreased, infections can quickly rise again. In many countries, the first wave (constantly increasing infection rates) is still observed.
As can be seen in particularly vulnerable institutions (e.g. currently slaughterhouses) or in places of events where adequate protective measures have not been observed, the infections can reach high numbers; and wherever there is a superspreader (person who is particularly infectious but do not have to be more severely ill at the same time) a new wave can form again and again in the absence of herd immunity. This happens faster if infectious people cannot be detected and isolated in time. Also, in churches, for example, where singing took place, there were sometimes more spreads when a superspreaderwas there.
Herd immunity (community protection) consists when a sufficiently large group of persons or animals is protected by their own immune system against infection and thus the infection of a few could not spread to many more people. Such immunity is achieved when so many in the group have become immune to the disease through vaccination or previous illness, and each new chain of the infection quickly breaks down, so that even non-vaccinated people are hardly or no longer infected.
In the case of measles, herd immunity is seen when approximately 85-95% of the population is immunized (vaccinated in the sense of public health); in diphtheria, herd immunity can be seen from 80% of immunized people.
At COVID 19, it is not known exactly when herd immunity will be achieved. It is estimated that 60-70% of people need to be immune against further COVID-19spread to essentially stop or even eradicate.
Since the herd immunity of defined viruses vary from one country to other countries, global exchanges can lead to a resurgence of previously eradicated infections when vaccinations and thus herd immunity has decreased again in one country. For example, measles had been eradicated in Germany for more than 20 years when a student brought measles from Guatemala back to Germany in 2018, where measles was able to regain due to the slackening vaccinations.
Many factors influence herd immunity, not just the infection rate or vaccination rate.
It must be expected that the number of cases can rise again and that the second wave of COVID-19 can occur.
It is not possible to predict when a second wave could begin in Germany or other countries and how strong it would be. This depends on many factors, such as possible seasonal effects, the maintenance and compliance with infection protection measures, the mobility of the population and the rapid detection of outbreaks, and contact between infected persons.
Individual behavior (rules of conduct and recommendations for protection against COVID-19) plays an important role. Without these measures, the virus can spread uncontrollably. This is due to the high infectivity of often undetected infections (especially in the first days and often still asymptomatic histories) and the current lack of immunity in the population. This can quickly lead to an exponential increase in new infections. More subsequent waves of varying dimensions are possible under these conditions.
Whether the activity of COVID-19 is influenced seasonally is not yet certain. Many viruses that cause acute respiratory diseases generally spread worse in the summer. However, as it is shown in Brazil during the summer there, this virus spreads very quickly in correspondingly poor hygienic conditions, too low distance compliance, and often generally low health status in certain population groups even in the warm season.
Such seasonality with a decrease in infection in the summertime has been observed in other human coronaviruses (respiratory viruses).The reasons there seem to be the higher temperatures, the higher UV radiation and also the fact that people are more outdoors in the summer with better air exchange.
6. Immunity - COVID 19 after infection
Studies have shown that individuals develop specific antibodies after COVID-19infection. In the majority of patients, this seroconversion takes place in the second week after the onset of symptoms or also asymptomatic infection. Then a protective immunity is to be expected. It is still unclear how regular, how effective, and how permanently this immune status is built up. Experience with other coronavirus infections (SARS and MERS) suggests that immunity could last up to 3 years.
Based on previous findings from SARS research, experts believe that recovering patients have a very low risk of reinfection. For reliable statements with this new strain of the virus, larger studies over longer periods of time are necessary.
7. What is the goal? What to do?
Waiting for vaccination and as long as the contact restrictions are in place? Avoid or restrict major events such as concerts, fairs, major sports events, and other major events – but may also close some schools and kindergarten or have them used only to a limited extent?
As with the question of potential long-term damage, the question of the risk of opening up schools cannot yet be answered uniformly.
In Holland, after the relatively early reopening of schools, there were no major problems under the possible precautions, but other places, such as Israel, had many new outbreaks in these facilities shortly after the reopening, although only smaller groups were started there at first and only later, with good numbers, the normal class strength continued.
Obviously, there are always inconsistent rules of conduct (too little distance and lack of mouth-nose protection) that led to the infections; however, there must always be an infected person (especially superspreader) among them, because in some other institutions, which also did not always comply with much better prevention measures, there was no rapidly increasing number of infections.
This is misleading the population because no one can know at the moment when and where the superspreaders can be back.
The new rules will continue to exist for schools and kindergarten for a long time (more distance – small group sizes, better hygiene measures, partly e-learning, or homeschooling). As we have repeatedly emphasized, more attention should be paid to strengthening the immune system through lifestyle factors (especially diet), as this could be a plausible factor, for fewer infections or better immune defenses. Studies to this in the COVID-19 context do not yet exist. All we know is that such relationships can often play a role in infection. However, a healthy diet and other health-promoting lifestyle factors it is not an alternative to immunization, you will always need it.
With the question of an effective and safe vaccine, there is a high level of research, with huge financial resources and big hopes. However, it is not yet possible to show sufficient research data in this regard, which allows a better assessment.
It is still unclear if and when there will be an effective vaccine against COVID-19. There are no or only limited vaccines against most viral diseases. A vaccine must also be very effective because an existing partial immunity with e.g. 50% efficacy for 1-2 years (e.g. partial immunity via only a T-cell response) would pretend false security.
Also, some flu virus vaccinations have only partial immunity, i.e. some years a vaccination protection of 80% a different year but only 30%. In the case of influenza viruses, however, we are dealing with long-existing strains, whereas many people have already become partially immunized over the course of their lives and therefore the disease is not so severe for them, despite the inadequate vaccine. With COVID-19 this will take a long time.
8. What risks do we take in buying?
Pandemics have always existed – historically, this has been the "normal case" for centuries. There are always such and other life risks.
We must weigh up the most diverse connections with a sense of proportion so that different social structures work. Health aspects related to an infection risk cannot be considered isolated; the question of a functioning social structure and public health correlates with more than the risks of infection. Social factors that require a certain degree of "prosperity" or the maintenance of livelihoods play important roles, as do the ecologically harmonizing structures.
The lockdown was important, but it can no longer be sustained without other problems increasing over time(some undesirable side effects of “therapy”). Therefore, the rules of conduct, such as keeping distance and thus the avoidance of major events with many people, remains a particularly important measure until a higher immunity in the population is achieved.
In the context of COVID 19, we all do not yet know which is the right way forward. We must learn to live with risks. History over the centuries has taught us that better hygiene and quarantine (as well as, in a milder form, the greater distance from infectious people) are the solution over time. Vaccinations, where they are possible or effective, help a lot, but we often do not have vaccines.
We need interdisciplinary assessments - expert councils not just from the field of virologic consideration. The subject is never monocausal, but always multifactorial.
Mass events are often a particular challenge in both the social and biological sense. Where many people come together in a confined space, there is always a field for more infections.
Until herd immunity, whether through infections or vaccinations, is achieved, the challenges will remain. If there are superspreaders in the tighter contact area, new infections can also increase independently of mass events or cramped conditions (e.g. in buses and trains or possibly aircraft).
The reactions must be adapted to the respective situations and to the conditions. Where certain events, trips, meetings, school and kindergarten visits, etc. are possible in some places, this cannot be the case in other places at certain times if you want to avoid higher infection rates.
Since the distance rules, hygienic measures and the mouth-nose cover cannot provide absolute infection protection, it is always important to recognize infectious persons and especially the superspreaders (e.g. via suitable tracking with an APP and good tracking by health authorities) and then to make the distance to others even greater, i.e. to observe a quarantine of these people and your closer contact persons until there is no longer any risk of infection.
This time span can be very different and is not the same as the incubation period of up to 14 days. The maximum incubation period – i.e. the time between the possible infection and the occurrence of symptoms, should not be misinterpreted with the course of the disease and the time of infectivity.
Previously, quarantine was generally recommended for 14 days even in suspected cases of the first degree (these are potentially infected people who are still asymptomatic or do not yet have positive pathogen detection).
Today, people are only quarantined if the test result is positive.
The testing should take place on the 1st and between the 5th-7th day after contact with an infected person.
The duration of the quarantine is extended depending on the course – the involved health department and the treating physicians determine this.
If symptoms occur, the course of the disease and the therapy determine the further necessary measures.
To reduce the risk of transmission in:
- the rapid isolation of positively tested persons,
- the identification and early quarantine of close contact persons(quarantine if they are positive),
- the keeping distance from other persons,
- the good compliance to hygiene rules
- and the wearing of (every day)masks
- There are still many areas in the state of In the sense of researching a new strain of the virus it is still far too short to be able to assess reliably important correlations – especially the long-term consequences.
One of the key questions will always be: how many infections do we want or can tolerate?
For COVID-19, total avoidance is not yet possible; and even in the case of vaccination, if it should be effective, it will not provide 100% protection. As shown above, this virus is rather harmless for most people, but so dramatically risky because it can be transmitted by many people who are symptomless and is very dangerous for certain people (risk groups). The high number of infections and diseases in these people is evident worldwide.
9. Code of Conduct Recommendations of the Federal Centre for Health Education - Germany
Observe the DHEM-formula - distance - hygiene- everyday masks:
Keep distance:
- Make sure you have a minimum distance of at least 5 m from other people.
- Avoid shaking hands or hugging
Observe hygiene:
- Follow the hygiene rules regarding sneezing, coughing and hand washing >> sneezing or coughing only in your own arm bend or in a handkerchief and then dispose of.
- Keep your hands away from your face >>do not touch inattentive your face (especially not the mucous membranes on your mouth and nose, but also not the eyes)
- Wash your hands regularly* and sufficiently long (at least 30 seconds) with water and soap * in everyday life routinely
Wash hands:
- if you cough, sneeze or brush your nose
- if you come from shopping or other public places
- and also before putting on and after putting off the mouth-nose cover
- before and after contact with other people
Wear everyday masks with mouth-nose cover:
- where you talk to other people outside the family and close circle of friends, where you could have continuous contact; and where it is prescribed (public transport, shops, etc.).
- Also, with such covers in the appropriate places keep a minimum distance of 1.5 m to other persons Stay informed about the current regulations.
- The cover must completely cover both the mouth and the noses!
For mouth-nose covers, care should be taken to change them more frequently, or to be washed with soap and hot (at least 60°C) where possible. Depending on the intensity of use, these covers should be renewed after continuous use, e.g.6 hours. Depending on the condition, an earlier exchange is sometimes necessary.
The covers that are visibly contaminated from the inside or defective cannot be used or reused.
Depending on the locally up-to-date infection data, additional rules or measures are recommended in addition to the above rules of conduct:
- Stay at home in the regions of current infection (watch out for the reports of the authorities) as often as possible. Or do not stay outdoors close to strangers (especially larger groups).
- Change indoor air regularly at home and also at indoor workplaces (the more often the better).
- In particular, limit personal encounters with elderly or chronically ill people to protect them. Instead, use more communication through phone, email, video calls, etc.
- For meetings with others meet outdoor - e.g. for walking, for sports or on the playground. However, do not meet in larger groups and always keep the recommended minimum distance of 1.5m to other people.
- Do not organize or attend larger private meetings with people from multiple households – whether at home or at others (e.g. birthday parties, play arrangements for children or movie nights)
- Strengthen your body's own defenses with a healthy lifestyle (at least one hour of exercise every day and more often a week extra exercise, enough sleep, balanced diet with healthy foods (abundant fruits, vegetables, salads, legumes, kitchen herbs, whole grains, reduced-fat dairy products and seeds; moderate fish and moderately low-fat meat).
- Limit your alcohol consumption
- Avoid any smoke (no smoking or passive smoke)
- If a person in your household is ill, make sure that you have a spatial separation and sufficient distance from the rest of the household.
- If you yourself have signs of illness that may be related to a COVID-19 infection, it is important to stay at home and, if necessary, seek advice by telephone from the hotlines of the health authorities or other bodies set up. If there are more signs of the disease, contact a doctor.
- Do not delay necessary doctor visits for other illnesses.
- Observe visiting regulations for hospitals, nursing, senior- and disabled-facilities.
- Help those who need help! Provide elderly, chronically ill relatives or neighbors, and single and needy people with food and everyday necessities. To protect these people, it is best not to enter the apartment, but to make purchases at the door or place them there.
- Do not be afraid to use telephone services such as telephone pastoral care or other crisis services if necessary. You can also find helpful information, e.g. in Germany, on the Internet portal of the Federal Ministry of Health.
- Hotlines have been set up in many places to provide telephone consultations on questions relating to family life.
Find out more on the website of your municipality or city.
Disinfectant also in private households?
In the current situation, does it make sense to use disinfectants in private households?
The Federal Institute for Risk Assessment sees no need for healthy people to usedisinfectants in their private households, even in the current situation. Normal hygiene measures such as frequent and proper hand washing with soap and regular cleaning of surfaces and doorknobs with for household usable surfactant-containing detergents and cleaning agents provide sufficient protection against the transmission of the COVID-19 virus by a smear infection.
- In exceptional cases, the targeted use of disinfectants may also be appropriate in private households if recommended by a doctor.
- The disinfection measures to be carried out when an infected person lives in quarantine in the household must be discussed with the competent health office or the attending physician.
Work-related environment
- If possible, work from home, in consultation with your employer.
- If possible, make arrangements by e-mail or phone. If possible, use telephone or video conferencing to exchange in the group.
- Mandatory meetings should be held as short as possible and with a few people in a well-ventilated room.
- Keep a distance of at least 1.5 meters and avoid touching, such as greeting by shaking hands.
- Organize your workflows so that you have as little as possible direct contact with your colleagues, even during pause.
- If possible, work individually or in small fixed teams (e.g. in the office or on construction sites)
- If possible, do not share workstations or objects (such as keyboards, tools) with other people. If this is not possible, clean your workplace thoroughly, especially when leaving or taking up service. Outside the health service and home care, the use of commercial household cleaners is sufficient. In individual cases, disinfection may be required if, for example, the workplace has been used by a sick person.
- If possible, take your meals alone (e.g. in the office). If you use pause rooms or the canteen, keep sufficient distance from colleagues.
- Stay at home if you are sick contact your doctor and cure yourself!
Public transport and travel
- Keep as far as possible away from people when you are travelling by public transport, use the less busy off-peak times if possible. In all federal states, you are obliged to wear a mouth-nose covering on public transport.
- You can also use your bike, walk or drive your own car as far as possible. But don't carpool with people from other households.
- The Federal Government warns against unnecessary tourist travel abroad – and also within Germany. If you are still travelling, inquire in advance about the regulations of the states or regions.
Public life
Please inform yourself about possible regional or local measures to be observed. The respective regulations of the individual federal states can be found on the website of the Federal Government.
- Avoid crowds and observe the specified distance rules of at least 1.5 meters.
- Visit public institutions only where strictly necessary, such as offices, administrations, and public authorities. Many facilities currently offer telephone processing.
